§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Ernest G. Perry.]
§ 3.16 p.m.
§ Mr. Keith Speed (Meriden)This afternoon I raise a matter which is causing great concern in part of my constituency and which has been a very real tragedy to a young family who are my constituents living in Tamworth. I know the matter is one which interests the Under-Secretary of State, because he and I both have the honour to represent the Borough of Tamworth.
It concerns the death of a baby girl, a death which, in the words of the coroner at the inquest, was caused by a natural disease which might have responded to treatment had the child been seen by a doctor at the time the mother wanted it seen.
I shall set out the main facts of the case which, with one exception, are not in dispute. It appears to me and to many of my constituents that some aspects of the local medical organisation faced with a very special emergency were inadequate, and that, in the words of the coroner there were
loopholes in the administrative system".It is not my intention to embark on a witch hunt or personal campaign against any individual or institution. That would, I believe, be unfair and unhelpful. I know that the medical profession in Tam-worth is itself deeply disturbed about this 1813 case. It is in that spirit that I shall put a number of questions to the Under-Secretary of State on matters which, I think, need remedial action to see, as far as humanly possible, that this sort of tragedy cannot be repeated. Health centres are being put up all over the country, and it is more than possible that this sort of case could occur elsewhere. I hope, therefore, that there can be the widest possible publicity through the professional journals so that all the various medical authorities can examine their own organisations wherever they may be.Lorraine's mother, Mrs. Harding, first noticed something wrong on the evening of Friday, 13th June. She saw that the child had been sick in her cot. I should, perhaps, explain that Lorraine was nine months' old. The next day the child was sick. It had diarrhoea. Mrs. Harding went to the local chemist who gave her some medicine for the child and, quite properly, advised her to see her doctor if the child did not get better over the weekend.
There was no improvement, and on Sunday, 15th June, she called in the doctor, not her own doctor, but the one at the health centre on emergency call that day. He visited the child and told Mrs. Harding to give it water and milk, and he left a prescription. He did not record the visit in the health centre records as he thought it was a routine case. That evening the diarrhoea and sickness had more or less cleared up, but the next morning, Monday, 16th June, the child appeared to be far from well, it was moaning, and seemed to be very weak.
At 11 o'clock that morning Mrs. Harding tried to telephone the health centre, but, during the hour and a half she attempted to do so, every time she tried the line was engaged. She has no telephone in her own home, and she was ringing from a nearby kiosk. She returned home, where friends were looking after Lorraine, and the child seemed a little better, but during the afternoon the child's condition began to deteriorate again and Mrs. Harding tried again to get through to the health centre, starting at ten minutes to four. She eventually got through at 20 minutes past.
Mrs. Harding spoke to a receptionist and was put through to someone else, 1814 not a doctor, and explained the circumstances, and how weak the baby was, and asked to see a doctor, and said she was quite prepared to take the child to the health centre if a doctor would see her there. She was told that the doctor had said that it would take two days for the baby to pick up, and another prescription would be available for collection at 6 o'clock that evening. During this time the baby was at home being looked after by friends.
When she got home from the telephone kiosk, Mrs. Harding was worried about the appearance of her daughter. She put her in a carrycot and went in a friend's car to Tamworth General Hospital. She there asked for medical attention for the child. First, she saw a receptionist, and later on a sister at the hospital.
Here we come to a discrepancy in the evidence as revealed at the inquest. Mrs. Harding claims that the sister told her to go to the health centre for a prescription and made no reference to her seeing a doctor at the centre. The sister claims that she telephoned a doctor at the health centre and was told to send Mrs. Harding and the baby to the centre where the doctor would see the child.
Whichever story is correct, Mrs. Harding by now was thoroughly confused and, in her own words to me, feeling rather guilty at the fuss she was making. She arrived at the centre in the friend's car and was given a prescription by the receptionist. Nothing was said to her about a doctor seeing her baby, and in evidence at the inquest the receptionist at the health centre said that she was given the prescription by a doctor and told that Mrs. Harding would be collecting it, but nothing was said about the doctor wanting to see the baby.
Mrs. Harding collected the prescription from the health centre and she did not see a doctor. She was wondering whether she was making a great fuss about nothing. She went home with the baby, gave the baby her medicine, and at 11 o'clock that night the baby seemed to be better than she had been earlier in the day.
The next morning Mrs. Harding's eldest daughter, aged 3¾, went into her little sisters' room and found her dead in the cot. The cause of death was enterocolitis, and the pathologist at the inquest 1815 said that with proper treatment there was a chance that the child would have recovered.
The questions that arise from this matter are as follows. First, in view of the delays and difficulties in getting through to the centre, are the telephone facilities and the lines to the centre adequate, because on the evidence of this case, certainly in the middle of June, they would not appear to be so?
Second, is it clear to everyone what are the capabilities and responsibilities of a general practice hospital like the Tam-worth General Hospital? To a lay person a hospital is a hospital, but if a hospital cannot raise a doctor quickly because it is a general practice hospital, this should be widely known so that misunderstandings of this sort cannot occur.
The third and vital point is the organisation in health centres, particularly in the doctor-patient relationship. What are the qualifications of people who answer the telephone when patients ring up? On what criteria do receptionists or people at the end of telephones at health centres decide whether a patient is or is not to be put promptly in touch with a doctor?
Although I realise that I am on contentious ground here, I would go so far as to suggest that a mother of a child aged two years or under who is seriously concerned and who telephones the health centre or anywhere else should be able to speak to the doctor directly as of right. We all know that the first two years of a child's life are the dangerous age, and that a child can recover from or decline in a remarkably quick time when suffering from what might be quite minor ailments in older people. The Minister will know that I have a personal interest in this matter. It is essential that the doctor should get information at first hand from the mother. There is a danger of building up a barrier so that parents may call upon doctors when it is too late rather than too early.
There is a national problem. Doctors, who are very busy people, must be protected from frivolous calls, but very young children are in an exceptional category. They cannot speak for themselves, and a mother of a child up to the age of two should have a right to speak 1816 directly to a doctor when she is concerned about her child. If sometimes the case may be trivial, I am prepared to accept, and I hope that the medical profession is, that in other cases there will be serious cause for alarm and that it is right and proper that the mother should speak directly to a doctor.
Does the Minister agree that all emergency calls by doctors from health centres during the weekend or occasions of that sort should be recorded on return to the health centre whether or not the case is routine, particularly in respect of young children where a case is rarely routine because the child's condition rises or falls so quickly? It was clear that in this particular case proper information was not passed on from the doctor who was on emergency call and called on Sunday to Mrs. Harding's own doctor who subsequently dealt with the case.
As far as this particular case is concerned, if the hospital sister's story is true, then the communications between doctor and receptionist in the health centre when Mrs. Harding was sent there by the hospital seem to be not very satisfactory. If the doctor wished to see the baby, as he claimed he did, then instructions to that effect should have been given to his receptionist, but no mention was made of it, only instructions regarding the prescription. One cannot expect a distraught and worried mother, who is beginning to wonder if she is making a fuss over nothing, to barge straight into the doctor's surgery, bypassing the receptionist. Is the Minister satisfied that the workload of the health centre in Tamworth is not too great, bearing in mind the rapid growth of the area both in his constituency and in mine?
I feel that this case raises national as well as local issues. Mrs. Harding, who is an intelligent and conscientious mother cannot be criticised in any way. All the action she took I should imagine my wife would have taken, or, indeed, the wife of any hon. Member present in the same situation. Certainly, Mrs. Harding cannot reproach herself in any way for what she did in this tragic affair. Yet I feel that due to the complexities and growing workload of modern medicine, new barriers are growing between general practitioners and their patients. It is a factor I view with great concern. I would 1817 give maximum weight to this factor in any reorganisation of general practice.
If this very real tragedy to the Harding family makes everyone, not just in Tam-worth but throughout the country, take a long, hard look at their practices and procedures, then little Lorraine Harding's untimely death may save other lives.
§ 3.27 p.m.
§ The Under-Secretary of State for the Department of Health and Social Security (Mr. Julian Snow)I am grateful to the hon. Member for Meriden (Mr. Speed) for raising this question, which arises from the death in Tamworth of the nine months' old child Lorraine Harding. He has mentioned the fact that I also am one of the hon. Members for Tamworth. I was very sorry indeed to read of this very sad event. Scrutiny of services which appear to have malfunction can sometimes be distressing, but the death of a young child is especially sad. I should like to take the opportunity which this debate gives me to express my very deepest sympathy with Mr. and Mrs. Harding.
Since the health centre concerned was built following activity by myself over a number of years I am particularly anxious to ensure that the local services learn whatever lessons there can be learned from the circumstances leading to Lorraine's death. The administration of this health centre was for a long time a matter of dispute between the Staffordshire County Council, as local health authority, and the doctors who were in the original scheme, and I am, therefore, the more anxious to try to help as far as I can.
For reasons I will explain later nothing I have to say this afternoon is intended to involve a criticism of any person or persons' professionally or otherwise concerned in this unhappy affair.
Before dealing with the points raised by the hon. Gentleman I should mention a factor which to a considerable extent must inhibit me in what I say. There is a statutory procedure for investigating complaints against the practitioners who enter into contracts with executive councils to provide the services for which councils are responsible.
This procedure, the Service Committee procedure, is set out in the National Health Service (Service Committees and 1818 Tribunal) Regulations, 1956. It is peculiar to the Health Service, but it can result in a practitioner being found to be in breach of his terms of service which form part of his contract with an executive council.
Under the service committee procedure it is open to the parents of Lorraine Harding to make a complaint to the Staffordshire Executive Council that the doctors on the council's medical list who appear to be concerned did not comply with the terms of service. I understand that to date no such complaint has been made, but if the parents decide that the complaint appears to be justified, they should write to the Clerk of the Staffordshire Executive Council within six weeks of the event giving rise to the complaint, stating the substance of the matter which they wish to have investigated.
It would be open to the hon. Gentleman to assist Lorraine's parents in making any complaint that they decide to make. The executive council can refer any matter relating to general medical services to a medical service committee for investigation under the regulations I have mentioned. I understand that the appropriate committee of the council will be considering at its meeting next Tuesday whether it should refer this case to its medical service committee for investigation.
The service committee would report on its investigation to the executive council, which would then take a decision on the report. A complainant or respondent has a right of appeal to my right hon. Friend the Secretary of State for Social Services against a decision of an executive council which is adverse to him. In view of the possibility of a medical service committee investigation into this sad case and the further possibility of an appeal to my right hon. Friend, the hon. Member will understand that it would be wrong for me to comment on the actions of the general practitioners involved in this case.
I should perhaps also mention that my right hon. Friend the Secretary of State has no powers under the regulations to require an executive council to refer a matter to a service committee for investigation. The decision to make such a reference is entirely a matter for the Staffordshire Executive Council, at Stafford.
1819 The events leading up to the very sad death of this child were related, so far as I am aware with accuracy, by the hon. Member, although I cannot entirely endorse everything he said. I do not wish to relate the circumstances again—the particular aspects of the case are as the hon. Gentleman has mentioned. For the reasons I have given I would not want to venture opinions on the reasonableness of the actions taken by the doctors or their staff. However, I can deal with some of the points raised by the hon. Gentleman by explaining the arrangements for the administration of the Tam-worth Health Centre.
The centre opened for the provision of local authority services early in December of last year. General medical services by family doctors were first provided there in February and a second partnership joined the centre early in March. The first hospital consultant started sessions at the end of January and other consultant services began in April. The family doctors delayed their entry into the centre because they felt that under the arrangements originally proposed by the Staffordshire County Council, which was the local health authority concerned, they would not have sufficient control over the running of the centre.
However, these difficulties were resolved and it has been agreed that the centre should be controlled by a professional committee consisting of three family doctors, three officers of the county council and a doctor nominated by the regional hospital board. Subject to the formal confirmation of the county council this professional committee is responsible for the appointment of staff within the agreed establishment, and for the organisation of the day-to-day running of the centre, including allocation of duties to staff and the preparation of rotas.
Although the staff is on its payroll the county council has sought to leave day-to-day administration of the centre to the doctors working there, but at the same time to meet as quickly as possible all reasonable requests made of it by the professional committee. An example of this is the installation of additional telephone lines. On 23rd May, the council was 1820 informed that the professional committee had asked for the installation of three additional outside telephone lines to the centre. These were in operation by 28th May. I understand that the county council has received no further request from the professional committee for additional lines.
Whether or not the number of doctors and ancillary staff at the health centre is adequate is a difficult question to answer. There are eight family doctors practising at the centre in two partnerships of four, and this is the number of doctors for whom the centre was planned. There is no fixed complement of general practitioners in any area against which a shortage could be measured.
The Tamworth area is "designated" as under-doctored and initial practice allowances are, therefore, available to encourage doctors to begin practising there. Allowances of a different kind are available to doctors already practising in areas such as this which have been continuously "designated" for over three years.
However, family doctors in the Health Service are independent contractors and my right hon. Friend has no power to direct them to practise in particular areas.
As regards ancillary staff at the centre—that is to say, receptionists and people like that—it is really a matter for the professional committee to decide how many staff it needs and then, as I have said, to seek the approval of the county council to the employment of any additional staff that are needed.
On 1st April this year, when the ancillary staff at the centre became employees of the county council, there were the equivalent to seven and a half whole time clerical and receptionist staff. The professional committee considered that the number of clerks and receptionists should be increased from this figure to the equivalent of nine whole time staff, primarily to meet the needs of the family doctors.
The county council agreed to this, and I understand that an advertisement has been placed for an additional whole time clerical assistant and that some of the existing part-time staff will be working longer hours. If the professional committee consider that more staff are needed, 1821 its proposals will no doubt be considered by the county council.
As I have already said, the organisation of the duties of ancillary staff at the centre is largely a matter for the professional committee. It is up to the doctors working at the centre to decide the functions of their ancillary staff. Family doctors are responsible for the organisation of their practices and, thus, for the acts and omissions of their ancillary staff. Doctors have to draw the line somewhere between being too accessible and being inaccessible to their patients, but, in drawing this line, they must have regard to their obligations under the terms of service.
For example, a doctor is required to provide a patient with all proper and necessary treatment; to visit and treat him if his condition so requires; and to refer him, if necessary and with his consent, to the hospital and specialist services. If a doctor organises his affairs in such a way as to raise the question whether his obligations may not have been properly discharged, he may make himself liable to being found in breach of his terms of service under the service committee procedure.
Subject to certain conditions a doctor can make arrangements for another doctor to deputise for him, but he is liable for that doctor's acts and omissions under the terms of service, unless the deputising doctor is on the medical list of the same executive council—as was the deputy doctor hi this case.
The hon. Gentleman will see, therefore, that the terms of service lay certain obligations on family doctors in principle, and it is up to them to organise their own practices to ensure that their obligations under the terms of service are fulfilled. Matters such as communications between one doctor and another in a partnership and doctors and receptionists are very much matters of individual practice organisation. I should not like to comment on the practice organisation at the centre in view of the possibility of a service committee case.
The hon. Gentleman raised the question of the rôle of Tamworth Hospital in this case. I should perhaps explain that Tamworth Hospital is a 68-bed general practitioner unit. Medical cover, including that for casualty services, is provided 1822 by local general practitioners in contract with the hospital management committee. The arrangements are in accord with the Department's advice to hospital authorities that accident and emergency services should be concentrated in major centres—in this case probably Good Hope District General Hospital—and that serious cases should be taken to such hospitals; and that hospital boards could consult executive councils, which are responsible for the general practitioner services, and local medical committees on ways of arranging for patients in less serious need to be treated by general practitioners.
In cases of emergency at Tamworth Hospital contact would be made with either the general practitioner casualty officer on call for attendance at Tam-worth Hospital or with the patient's own general practitioner, if this doctor had a contract with the Management Committee and had beds at the hospital. It would be the responsibility of the general practitioner approached to arrange for a patient's admission to Tamworth or another hospital if this were required.
The on-call casualty duties at Tam-worth Hospital are shared between 12 doctors. There does not appear to have been a breakdown of arrangements in the case of Lorraine Harding, as a doctor appears to have been consulted as soon as the child arrived at Tamworth Hospital.
I share the hon. Gentleman's concern over the death of this young child. The authorities and individuals concerned are naturally distressed as well, and are considering what steps should be taken as a result. In view of the possibility of an investigation under the service committee procedure, I would not like to comment further, but I am grateful to the hon. Gentleman for raising the matter.
The hon. Gentleman also mentioned the question of recording messages of an emergency nature which might be taken by a doctor on call, say, at the weekend. I note this point, and no doubt my words will be read by the appropriate authorities.
I am grateful to the hon. Gentleman for raising the case. He said, I think quite rightly, that it may conceivably be something that requires attention in the matter of practices—I do not mean medical practices, but the efficiency of 1823 operational practices at other health centres.
The hon. Gentleman's speech and what I have said will no doubt be examined by other authorities—local health authorities and other practitioners. The House 1824 is indebted to the hon. Gentleman for raising the case as he has, in a very moderate way in the circumstances.
§ Question put and agreed to.
§ Adjourned accordingly at eighteen minutes to Four o'clock.